Bangalore.
Annexure- II
Proforma For Registration Of Subjects For Dissertation
1. / NAME OF THE CANDIDATE AND ADDRESS
(IN BLOCK LETTERS) / DR.NAVEEN.T.M.U. MBBS.
S/O UMAPATHAIAH.M.
KAMANBAVI EXTENSION, THIRD CROSS.
CHITRADURGA. 577501
2. / NAME OF THE INSTITUTION / KARNATAKA INSTITUTE OF
MEDICAL SCIENCES,HUBLI-22.
3. / COURSE OF STUDY AND SUBJECT / M.D. IN GENERAL MEDICINE.
4. / DATE OF ADMISSION TO COURSE / 29-04-2010
5. / TITLE OF THE TOPIC / THE STUDY OF SPECTRUM OF ACUTE RENAL FAILURE IN KIMS HUBLI.
6. / brief resume of the intended work:
6.1 NEED FOR STUDY:
In India acute renal failure constitutes 1.5% of all general hospital admissions, of which 60% are due to medical causes. Among the medical causes Acute diarrheal diseases, sepsis, infections like Malaria, liver diseases, snake bite are the major causes. others include surgical conditions, and pregnancy related complications.
Compared to western countries, median age for acute renal failure is relatively younger in tropical countries and is about 34years. Despite the substantial advances in renal replacement therapy and health care delivery, morbidity and mortality rates associated with the acute renal failure have remained high. The poverty, lack of medical fecility, ignorence, multiorgan dysfunction and indigenous system of medicine in the rural areas lead to late presentation and multiorgan dysfunction and the patients are pushed to a state of renal replacement therapy. All of them contribute to higher mortality than in developed countries.
The contribution of the disease burden has not been studied in most parts of INDIA. By studying the etiology, clinical pattern , and analyzing the outcome in acute renal failure, health care providers will be able to make a multi level approach to reduce mortality and morbidity.
Etiological spectrum of acute renal failure vary according to the geographical areas. There are no reported studies from northern Karnataka related to acute renal failure. This study was undertaken to study spectrum of acute renal failure in hospitalized patients in KIMS.HUBLI.
6.2 REVIEW OF THE LITERATURE:
Acute renal failure (ARF) is sudden decrease in the glomerular filtration rate (GFR) occurring over a period of hours to days and resulting in the failure of kidney to excrete nitrogenous waste products and maintain fluid and electrolyte homeostasis. Practically and in clinical trials ARF is defined as per the
RIFLE Criteria given below:
(Source : Results of the second Acute Dialysis Quality Initiative
consensus conference (May 2002).
1)The study of Etiology of Acute renal failure in a tertiary center in department of medicine Aga Khan University hospital, Karachi, Pakistan and department of Nephrology, the kidney center post graduate institute, karachi , Pakistan concludes that among all the cases of ARF 61 % were males. Medical cause accounted for 88%. Of the medical cause sepsis and dehydration were the commonest etiological factors of ARF. Majority of the patient had pre renal ARF. 27% Of patients had pre existing CKD. Who were classified as acute on CRF. The study highlights that early recognisation and management of prerenal causes of ARF will improve the prognosis of these potentially preventable causes.
2) The study of FACTORS AFFECTING THE OUTCOME OF ARF among the elderly population in India ; a hospital based study conducted in AIIMS NEW DELHI by S. MAHAJAN, S. TIWARI, S. K. AGRWAL gives results that ARF is more common in the age group of 60-62 years, males were 70.5%. volume depletion and sepsis being the most common precipitating factors. Poor out come is associated with more than 70 years age, under lying chronic illness, oliguria of more than 48hrs, need for RRT.
3)EPIDEMIOLOGY OF ARF IN HOSPITALISED PATIENTS, a study from Saudi Arabia over two years concludes that of the 150 cases of ARF, 58.7% were males, median age was 58.9 +/- 22.5 years. The incidence of ARF was 0.6% with median duration of ARF was 10.7+/- 9.2 days. 21.3% required dialysis. Majority of ARF, 62%, are acquired in hospital after the admission for other reasons. Medical causes were 62%. The commonest cause was ATN with sepsis being the leading cause of ARF. Good prognosis is associated with age less than 70, lowpeak BUN, hospital acquired ARF, short duration of ARF, no concomitant liver disease and no intervention with dialysis. In the study 40% died and 48% made full recovery.
4)THE PICARD (Program to improve care in ARD) experience which includes the study of spectrum of ARF in the ICU conducted by RAVINDRA L. MEHTA, MORIA T PASCUAL, GLENIN M. CHARTOW. Concludes that the median age was 59.5 years. Males were 59% there was extensive comorbidity associated with ARF. 64% required dialysis. Mortality was 37% the rate of mortality and non recovery of renal factors was 50%. The median hospital length of stay was 25 days.
5)EPIDEMIOLOGY AND OUTCOME OF ARF in hospitalized patients ; a national survey, conducted in division of nephrology, biostatistics research center, New England medical center, and division of nephrology St. ELIZABETH’S medical center, Boston concludes that ARF was more commonly coded for older patients with median age of 73. males were 51.8%. mortality was 21.3%. 7.5% required dialysis. ARF was second most frequent AOSD.
6.3 Aims and Objectives of this study;
1. To find out the incidence of acute renal failure in KIMS HUBLI.
2. To find out the spectrum of acute renal failure .
3. To analyse the outcome of acute renal failure cases
7. / MATERIALS AND METHODS :
7.1 SOURCE OF DATA:
A total of 100 patients of Acute renal failure cases from,KIMS hospital,Hubli,during the period of January 1st 2011 to December 31st 2011 will be taken for study considering the inclusion and exclusion criteria.
7.2 METHODS OF COLLECTION OF DATA:
1)To select the cases for the study, Acute Renal Failure is defined as a sudden detoriation in renal function presenting either as oliguria (urine volume less than 400 ml/ day.) for at least 48 hours OR rise in S. Creatinine level of more than 50% of base line OR more than or equal to 2mg/dl.
2) The Socio demographical, clinical, laboratory, parameters and out comes were collected.
3) Demographic data includes Age, sex, ethinic back ground, and geographic location. 4)Clinical data were symptoms related to primary etiology of renal failure and its predisposing factors or involvment of other organs were recorded in detail. Past history of any diseases contributing to Chronic Kidney Diseases were elicited.
5)Laboratory investigations includes complete blood count, peripheral smear, urine analysis on 2 occasions, Blood urea, Serum Creatinine, Serum Electrolytes, USG Abdomen for all the patients. Wherever necessary LFT, Bleeding profile, stoolexamination , 24 hour urinary protein, and Renal biopsy will be done. 6) Information will be collected through a pre tested and structured proforma for each patient.
SAMPLE SIZE:A Total of 100 patients after considering inclusion and exclusion criteria will be taken up for study.
TYPE OF STUDY; PROSPECTIVE HOSPITAL BASED TIME BOUND STUDY.
Inclusion criteria :
1. Patient with increased Serum Creatinine at admission with no history suggestive of any Chronic Kidney Disease.
2. Patients with normal Serum Creatinine at admission and subsequent values increased as defined by the RIFLE criteria.
Exclusion criteria:
1. Patients who are known Chronic Kidney Diseases.
2. Patients who are lost to follow up.
3. Age less than 15 years.
Parameters used:clinical profile,.complete blood count, peripheral smear, urine analysis on 2 occasions, blood urea, Serum Creatinine, Serum Electrolytes, USG Abdomen for all the patients. Wherever necessary LFT, Bleeding profile, stool examination , 24 hour urinary protein, and Renal biopsy will be done.
Statistical Analysis; The data will be collected and interpreted using appropriate tests.
7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals? (If so, please describe briefly)
YES,
1 complete blood count,
2 peripheral smear,
3 urine analysis on 2 occasions
4 Blood urea,
5 Serum Creatinine,
6 Serum Electrolytes,
7 USG Abdomen for all the patients.
8 wherever necessary, LFT, Bleeding profile , stool examination , 24 hour urinary protein, and Renal biopsy will be done.
7.4 Has ethical clearance been obtained from ethical committee of your institution in case of 7.3?
Yes, ethical clearance has been obtained from the ethical committee KIMS, Hubli.
8. / List of References:
1) Etiology of acute renal failure in a tertiary center. RENAL DATA FROM THE ASIA - AFRICA. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTAION. Year 2008 volume 19. Issue 6. Page. 1009-1014.
2)Factors affecting the outcome of acute renal failure among the elderly population in India : A hospital based study. INTERNATIONAL JOURNAL UROLOGY AND NEPHROLOGY (2006) 38: Page .391- 396.
3) Epidemiology and Outcomes of Acute Renal Failure in Hospitalized Patients: A National Survey. CLINICAL JOURNAL AMERICAN SOCIETY OF NEPHROLOGY 2006. Page. 43-51.
4)Acute Renal Failure in the Intensive Care Unit. JAPI OCTOBER 2006 VOLUME 54.
5)Spectrum of acute renal failure in the intensive care unit: The PICARD experience. Kidney International (2004) 66.
6) Epidemiology of acute renal failure in hospitalized patients: experience from southern Saudi Arabia. HEALTH JOURNAL September – November 2003 Volume 9.
9 / Signature of the candidate
10. / Remarks of the guide
11. / Name and Designation
11.1 Guide / DR. VeNKATESH MOGER md. DM.(NEPHRO)
ASSOCIATE PROFESSOR,
DEPARTMENT OF NEPHROLOGY
KIMS, HUBLI.
11.2 Signature
11.3 Co-Guide
11.4 Signature
11.5 Head of the Department / Dr. H. MALLIKARJUN SWAMY.
PROFESSOR AND HEAD,
DEPARTMENT OF MEDICINE
KIMS, HUBLI.
11.6 Signature
12. / 12.1 Remarks of the Principal and Chairman
12.2 Signature
FROM,
DR.NAVEEN.T.M.U.
POST GRADUATE,
DEPARTMENT OF GENERAL MEDICINE.
KIMS, HUBLI
TO,
THE PRINCIPAL
KIMS, HUBLI.
(THROUGH PROPER CHANNEL)
Respected sir,
Sub: Submission of proforma for registration of subject for Dissertation.
I am here with submitting my proforma for registration of dissertation titled ‘’THE STUDY OF SPECTRUM OF ACUTE RENAL FAILURE IN KIMS HUBLI.”.Kindly forward this to RGUHS, Bangalore.
Thanking you,
Yours sincerely,
DR.NAVEEN.T.M.U.
Place: Hubli
Date: